Guiding Principles

As with any eligibility decision, the question of eligibility for special education under the category of Other Health Impairment (OHI) is an important one. Special education can provide much needed supports and insight for students with disabilities. At the same time, the identification for special education can impact the ways a student experiences school, and the mindset of the learner and those around them.

A medical statement is required for OHI, but it is only one piece of the evaluation. Special education decisions should never be made based on a single piece of data. A student may have a medical diagnosis, but the eligibility team needs to determine the impact of the medical condition on the student’s academic performance - particularly the impact on strength, vitality or alertness.

As with any eligibility decision, the team needs to determine not only whether a disability exists, but whether the disability has an adverse impact on the child’s educational performance and whether the child requires specially designed instruction. Many students may experience a health impairment such as ADHD or Anxiety, but it may not have an academic impact or may not require specially designed instruction.

Procedural Guidance

If a team is considering an initial eligibility of OHI for a student with ADHD, there should be clear documentation of interventions in the Child Study process. See the Child Study page in our district handbook or the National Association of School Psychologists (NASP) position paper on ADHD for more guidance (resources section below).

The team can accept a medical statement even if it is not on our district form. The OARs require:

• a diagnosis or description of the impairment, and
• a statement that the condition is expected to last more than 60 calendar days

Who can sign a medical statement as a medical provider?

• A medical statement must be signed by a medical doctor (MD), a psychiatrist licensed to prescribe medicine, Nurse Practitioner (licensed by a State Board of Nursing) or Physician Assistant (licensed by State Board of Medical Examiners)
• A psychologist, social worker, counselor or therapist is not considered a medical provider. This may lead to some confusion from parents. For example, a counselor may provide a “diagnosis” of anxiety or depression for insurance purposes - but that would not qualify as a medical statement for special education eligibility under OHI.

The Student Services office can help coordinate to get a medical statement. Some families may need significant logistical assistance to contact a medical provider and obtain a medical statement.

If a student moves in with an active Oregon eligibility for OHI, but their file does not include a medical statement, we provide services. But we also need to obtain a medical statement. We should aim to get the medical statement as soon as possible. It is absolutely necessary to obtain a medical statement before completing a 3 year re-evaluation (if the student does not have a medical statement on file).

The eligibility team should only consider Other Health Impairment if a health impairment is impacting the student - and none of the other eligibility categories apply. For example, if a student experiences anxiety that is related to Autism Spectrum Disorder or Emotional Disturbance, they should not be found eligible under OHI.

• This does not mean that a student cannot have multiple eligibilities including OHI. It just means that if the health impairment is the result of another disability, then they should not also be found eligible for OHI for the same impairment.
• This also does not mean that a student with anxiety must be found eligible for ASD or ED instead of OHI. However, if a team has found a student eligible for ASD or ED, and the anxiety is related to the ASD or ED, then the team should not also find the student eligible for OHI for anxiety.

In the Individuals with Disabilities Education Act (IDEA), Other Health Impairment is listed with the disability code #80

Resources

NASP Position Paper on ADHD - National Association of School Psychologists

IDEA's Definition of OHI - Center for Parent Information & Resources

FAQ’s

What health impairments are listed in the IDEA definition of OHI?

IDEA specifically lists  a number of conditions that could qualify under OHI: asthma, ADD/ADHD, diabetes, epilepsy, heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome.

What if a student brings a diagnosis that is not listed in IDEA (like Sensory Processing Disorder, Sensory Integration Disorder, Central Auditory Processing Disorder, Developmental Coordination Disorder or Social Communication Disorder)?

IDEA’s list is not exhaustive. The language says the limited strength, vitality or alertness “is due to chronic or acute health problems such as…” This means the health conditions listed in the previous FAQ are not the only ones that could qualify for OHI.

When the team is considering OHI for a condition not specifically listed in IDEA, there are two major considerations:

1. Does the student’s condition impact strength, vitality or alertness?
2. Is the student’s condition better described by another eligibility category (Autism, Communication Disorder, Specific Learning Disability, Emotional Disturbance, Traumatic Brain Injury, Intellectual Disability, etc.)
   • Example 1: A student with Down Syndrome may fit many of the descriptors for eligibility under OHI. However, an eligibility of Intellectual Disability may be a more accurate identification. (Of course, this does not mean that we should assume a student with Down Syndrome automatically qualifies as a student with an Intellectual Disability. The eligibility team should always closely consider all available data when making eligibility decisions.)
   • Example 2: A student with autism may experience anxiety related to their autism. As a result, they may fit many of the descriptors for eligibility under OHI for anxiety. However, an eligibility of Autism Spectrum Disorder may be a more accurate identification (Of course, a student with a medical diagnosis of autism does not automatically qualify for an eligibility of ASD. The eligibility team should always closely consider all available data when making eligibility decisions.)

If the medical statement (provided by an authorized medical practitioner) includes a description of the student’s condition and the factors that limit strength, vitality or alertness, but the medical statement does not specifically provide a diagnosis (ADHD, diabetes, etc.) can the team accept this medical statement?

Yes. The language in IDEA says the medical statement indicates a diagnosis “or a description of the impairment.” Remember, the team still needs to determine educational impact and whether the student needs SDI. A diagnosis does not automatically lead to special education eligibility.